Clinical and Scientific Research

Medical Council of India's amended qualifications for Indian medical teachers: Well intended, yet half-hearted Sunita V S Bandewar, Amita Aggarwal, Rajeev Kumar, Rakesh Aggarwal, Peush Sahni, Sanjay A Pai Journal of Clinical and Scientific Research 2018 7(4):155-158

Utility of serum total and free prostate-specific antigen in combination with serum carbohydrate antigen 15-3 and carcinoembryonic antigen in breast tumours Pyreddy Swathi, N Lakshmanna, Kanchi Rama, AR Bitla, P. V L. N Srinivasa Rao, Hulikal Narendra, Yootla Mutheeswaraiah, Amancharla Yadagiri Lakshmi, BV Phaneendra Journal of Clinical and Scientific Research 2018 7(4):159-164 Background: Prostate Specific Antigen (PSA) is secreted by prostate gland as well as hormonally regulated tissues such as breast, ovaries and endometrium. We aimed to assess the utility of serum total and free PSA in combination with carcinoembryonic antigen (CEA) and carbohydrate antigen 15-3 (CA 15-3) in diagnosis of breast cancer. Methods: Seventy two female patients (38 with benign breast disease and 34 with malignant breast disease) who were histologically, cytologically confirmed with diagnosis of primary breast tumours were investigated. Serum total prostate specific antigen (PSA), Free PSA, CEA, CA 15-3 were analysed by enzyme linked immunosorbent assay (ELISA) method. Diagnostic performance of markers was studied using receiver operating characteristic curve and logistic regression analysis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Results: Patients with malignant breast cancer had significantly higher levels of all tumour markers compared to benign breast tumours. A significant decrease in total PSA, CEA and a statistically insignificant decrease in free PSA concentrations were seen in malignant breast cancer patients after surgery. Performance of total PSA was best among all the markers with 100% sensitivity, NPV, 94.7% specificity and 94.4% PPV. Conclusions: Serum total PSA is a good diagnostic marker to differentiate benign breast disease from malignant tumours compared to currently used CEA and CA 15-3.

Clinical manifestations, imaging findings and laboratory abnormalities in 51 patients with autosomal dominant polycystic kidney disease: Experience at Tirupati, South India KM Bhargav, B Siddhartha Kumar, Alladi Mohan, LR Aramadhaka, B Manoj Prajwal, D Prabath Kumar, B Vijayalakshmi Devi, V Sivakumar Journal of Clinical and Scientific Research 2018 7(4):165-169 Background: Autosomal dominant polycystic kidney disease (ADPKD) is an important cause of renal failure. Sparse recent data are available on clinical presentation ADPKD from India. Methods: We retrospectively studied the clinical presentation, imaging findings and laboratory abnormalities in 51 patients diagnosed to have ADPKD at our tertiary care teaching hospital at Tirupati, South India. Results: Their mean age at presentation was 49.1± 13.2 years; there were 32 (63%) males. Salient renal clinical manifestations at initial presentation included abdominal pain (47%); fever (35%), shortness of breath (33%); palpable mass per abdomen (25%); burning micturition (20%); haematuria (10%); and renal/ureteric caliculi (12%). Other manifestations were headache (21%); altered sensorium (12%); intracerebral bleed (8%) and chest pain (8%). Family history of ADPKD was present in 13 (26%) patients. On imaging studies kidneys were normal sized in 39%, enlarged in 59% and small sized in one patient; co-existent liver cysts were found in 12 patients. Hypertension (n = 20, 40%); chronic kidney disease (CKD) (n = 36, 71%) were evident at initial presentation. Other associated co-morbid conditions were type 2 diabetes mellitus (n = 6); Marfan's syndrome with mitral valve prolapsed and renal cell carcinoma (one patient each). Conclusions: In Tirupati, South India, ADPKD most commonly presented in fourth or fifth decade of life. Males were affected more frequently than females. Presence of CKD, hypertension at the time of inital diagnosis suggests that ADPKD is diagnosed late in the course of the disease. A high index of suspicion, specific diagnostic work-up including abdominal ultrasonography is required to diagnose ADPKD.

Comparison of intravenous dexmedetomidine and intravenous lignocaine for the prevention of conventional propofol injection pain: A prospective randomised double-blind study K Aditya, A Krishna Simha Reddy, Mangu Hanumantha Rao Journal of Clinical and Scientific Research 2018 7(4):170-174 Background: Pain on injection with propofol is a well recognized problem sometimes very distressing to patient. Current study compared the effectiveness of intravenous dexmedetomidine and lignocaine pretreatment for the prevention of propofol pain during induction of general anaesthesia. Methods: Ninety, American Society of Anesthesiologists (ASA) grade I and II patients were randomised into three groups of 30 each, Group D, Group L and Group N. Group D, patients received dexmedetomidine 0.2 μg/kg diluted to 5 ml of normal saline, group L, patients received 0.5 mg/kg preservative free lignocaine diluted to 5 ml of normal saline and group N, patients received 5 ml of normal saline. Intravenous access was secured with 20 G cannula and venous occlusion was applied to forearm using a pneumatic tourniquet inflated to 90 mm of Hg for 1 minute. The study drugs were injected over 5 seconds and after 1 minute venous occlusion was released and 25% of total calculated dose of propofol (2 mg/kg) was given intravenously over a period of 60 seconds. Severity of pain was evaluated using McCrirrick and Hunter scale at 0 seconds, 30 seconds and 60 seconds respectively and then remaining propofol and neuromuscular blocking agent was given. Results: The groups were comparable demographically. There was significant difference in pain scores assessed at 0 seconds, 30 seconds and at 60 seconds between the three groups. Conclusions: Dexmedetomidine in a dose of 0.2 μg/kg before applying venous occlusion by tourniquet for one minute in the same vein before inducing the patient with propofol was effective in decreasing the propofol injection pain when compared to lignocaine in a dosage of 0.5 mg/kg and placebo.

Trends of acute-phase dengue at a tertiary care hospital, Tirupati, Andhra Pradesh India Rishi Gowtham Racherla, Mudhigeti Nagaraja, Alladi Mohan, Usha Kalawat Journal of Clinical and Scientific Research 2018 7(4):175-178 Background: The present study was designed to know the trends of acute phase dengue in the Rayalaseema region of Andhra Pradesh state. Methods: This was a retrospective study conducted at Sri Venkateswara Institute of Medical Sciences, a tertiary care teaching hospital in Tirupati, Andhra Pradesh. Samples received for dengue NS1 testing from January 2011 to December 2015 were analysed. Results: During the study period, 6182 serum samples were received from cases clinically suspected to have dengue fever. Of these 690 (11.2%) tested positive. Positivity was significantly higher among females compare to males (12.1% vs 10.4%; P = 0.037). Children (19.2%) were more affected than adults (12.2%) and elderly (3.6%) (P < 0.001). Conclusion: Acute dengue infections were high in children compared to other age-groups with preponderance during post-monsoon and monsoon periods.

Significance of antimicrobial stewardship programme N Ramakrishna, R Jayaprada, KK Sharma Journal of Clinical and Scientific Research 2018 7(4):179-183 Antimicrobial resistance is an increasing threat in hospitalised patients and many of those are multidrug-resistant organisms. Antimicrobial Stewardship Programme (AMSP) has become a critical responsibility for all health-care institutions and antimicrobial prescribers. This aims mainly to optimise the antimicrobial use among patients to reduce antibiotic resistance, improve patient outcomes, safety and provide cost-effective therapy. This review describes the significance of AMSP, goals, strategies and key essentials for AMSP.

Lacrimal sac dacryolith Sri Ram Naresh, P Gopikrishna, N Harini Devi, P. V L. N Srinivasa Rao Journal of Clinical and Scientific Research 2018 7(4):184-186 Dacryolith are concretions observed in any part of nasolacrimal system, but stones within the lacrimal ductules are rare. Dacryolith are usually comprised of organic material, proteins and mucoproteins with approximately 20% amino acid content, epithelial cells and other debris. The clinical presentation and chemical composition of the dacryolith are variable. We report the case of lacrimal ductular dacryolith in a 10-year-old girl who presented with complaints of discharge of hard stone like material from the left eye. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and scanning electron microscopy with energy dispersive spectroscopy (SEM-EDS) analysis were carried out to find the chemical composition of the stone. The results showed 65 kDa protein indicating the presence of albumin and high amount of calcium carbonate in the stone substantiating the presence of albumin in lacrimal sac.

Falciparum malaria complicated by black water fever MS Madhuri, K Elavarasan, VP Benjamin, MS Sridhar, S Natarajan, V Chiranjeevi Journal of Clinical and Scientific Research 2018 7(4):187-188 We describe the course of falciparum malaria in a 28-year-old male patient who developed haemoglobinuria, black water fever following parenteral administration with artesunate. In the treatment of falciparum malaria, apart from quinine, use of other antimalarials, either singly or in combination are associated with the syndrome of blackwater fever.

99mTc-hydrazinonicotinyl-Tyr3-octreotide single-photon emission computed tomography–computed tomography in detection of functional neuroendocrine tumour in patient presenting with Zollinger–Ellison syndrome Manthri Ranadheer, SK Mehabunnisa, A Dinakar Reddy, DS Hemalatha, TC Kalawat Journal of Clinical and Scientific Research 2018 7(4):189-191

Skin diarrhoea due to scorpion sting G Sindhu, A Praveen, G Niveditha, D Prabath Kumar, B Siddhartha Kumar, Alladi Mohan Journal of Clinical and Scientific Research 2018 7(4):192-193